Kim Jun Hwee, Jeon Jimin, Heo Seok-Jae, Song Tae-Jin, Baik Minyoul, Yoo Joonsang, Kim Jinkwon
Department of Radiology Yongin Severance Hospital, Yonsei University College of Medicine Yongin Republic of Korea.
Department of Neurology Yongin Severance Hospital, Yonsei University College of Medicine Yongin Republic of Korea.
J Am Heart Assoc. 2025 Apr 15;14(8):e037950. doi: 10.1161/JAHA.124.037950. Epub 2025 Apr 10.
Thiazolidinediones are oral antidiabetic agents known for their wide-ranging pleiotropic effects, potentially offering cardiovascular protection. Using a nationwide health claims database in Korea, we evaluated whether thiazolidinedione treatment was associated with long-term cardiovascular prognosis after carotid revascularization.
This retrospective cohort study included patients with type 2 diabetes who underwent carotid endarterectomy or stent insertion in Korea between 2009 and 2020. The use of medications, including thiazolidinediones, was determined from prescription records, identifying exposure to medications within 30 days following carotid revascularization. The primary outcome was the composite occurrence of stroke, myocardial infarction, and all-cause death following carotid revascularization. A multivariate Cox regression analysis was conducted to assess the primary outcomes. The cohort included 14 220 patients with type 2 diabetes who underwent carotid revascularization (2669 via carotid endarterectomy and 11 551 via carotid stent insertion). Among them, 1034 patients received thiazolidinedione treatment. Over a mean follow-up period of 4.13±3.14 years, 4087 patients experienced a primary outcome. Thiazolidinedione treatment was significantly associated with a reduced risk of primary outcomes (adjusted hazard ratio [HR], 0.81 [95% CI, 0.71-0.93]; =0.002). The protective effect of thiazolidinediones was supported in a propensity score-matched analysis comparing thiazolidinedione users with nonusers (HR, 0.81 [95% CI, 0.68-0.95]; =0.013).
Thiazolidinedione treatment following carotid revascularization was associated with favorable cardiovascular outcomes in patients with type 2 diabetes. Further research is needed to explore the cardioprotective roles of thiazolidinediones in this high-risk group.
噻唑烷二酮类药物是口服抗糖尿病药物，以其广泛的多效性作用而闻名，可能具有心血管保护作用。我们利用韩国的全国健康保险理赔数据库，评估了噻唑烷二酮类药物治疗与颈动脉血运重建术后的长期心血管预后是否相关。
这项回顾性队列研究纳入了2009年至2020年期间在韩国接受颈动脉内膜切除术或支架置入术的2型糖尿病患者。通过处方记录确定包括噻唑烷二酮类药物在内的药物使用情况，确定颈动脉血运重建术后30天内的药物暴露情况。主要结局是颈动脉血运重建术后中风、心肌梗死和全因死亡的复合发生情况。进行多因素Cox回归分析以评估主要结局。该队列包括14220例接受颈动脉血运重建术的2型糖尿病患者（2669例通过颈动脉内膜切除术，11551例通过颈动脉支架置入术）。其中，1034例患者接受了噻唑烷二酮类药物治疗。在平均4.13±3.14年的随访期内，4087例患者出现了主要结局。噻唑烷二酮类药物治疗与主要结局风险降低显著相关（调整后风险比[HR]，0.81[95%CI，0.71 - 0.93]；P = 0.002）。在倾向评分匹配分析中，将噻唑烷二酮类药物使用者与非使用者进行比较，噻唑烷二酮类药物的保护作用得到了支持（HR，0.81[95%CI，0.68 - 0.95]；P = 0.013）。
颈动脉血运重建术后使用噻唑烷二酮类药物治疗与2型糖尿病患者良好的心血管结局相关。需要进一步研究来探索噻唑烷二酮类药物在这一高危人群中的心脏保护作用。
